The current practice in most ICUs is to help families make a decision about whether to withdraw life support within the first three to five days of the injury. A recent review stated that 72 hours of observation after the injury is “extensively supported in the literature” as sufficient for physicians to be confident in predicting a poor outcome.
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Yet this approach — trying to make a prognosis in three to five days — goes against the recent guidelines from the American Academy of Neurology. They argue that current ICU practice is based on flawed and outdated information, and categorically state that when “discussing prognosis with caregivers of patients with a disorder of consciousness during the first 28 days post-injury, clinicians must avoid statements that suggest these patients have a universally poor prognosis.”
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What’s needed now are better ways of predicting which patients in the ICU with severe brain injuries have the greatest potential for meaningful improvement.
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Until we have more information like this, however, families will have no choice but to make life and death decisions for their loved ones in the face of conflicting recommendations from medical experts.
Read full, original post: New guidelines on severe brain injury complicate already difficult decisions
